NPI | 1548857295 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 12206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.1690) |
363A00000X Physician Assistant (Licence: TX PA14169) | |
Enumeration Date | 2020-12-29 |
Last Update Date | 2024-09-02 |