NPI | 1508377011 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110744) |
Enumeration Date | 2017-10-24 |
Last Update Date | 2022-12-09 |