NPI | 1538649736 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5922) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 022457) |
Enumeration Date | 2018-08-16 |
Last Update Date | 2023-01-18 |