NPI | 1578176475 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 58722) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical (Licence: NV 69725) | |
Enumeration Date | 2020-08-28 |
Last Update Date | 2024-10-16 |