NPI | 1548221963 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA 9104152) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 23-011150) |
Enumeration Date | 2006-03-28 |
Last Update Date | 2009-06-02 |