NPI | 1497079164 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005913) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1336) |
Enumeration Date | 2010-03-24 |
Last Update Date | 2011-12-08 |