NPI | 1548288129 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA055695) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 6022969-1206) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2016-09-12 |