NPI | 1508325556 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601013249) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.006988) |
Enumeration Date | 2019-03-19 |
Last Update Date | 2025-09-28 |