NPI | 1538541628 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005403) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05783) |
Enumeration Date | 2015-06-24 |
Last Update Date | 2023-06-22 |