NPI | 1578988739 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2015018862) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 15-01807) |
363AM0700X Physician Assistant, Medical (Licence: OK 2347) | |
Enumeration Date | 2014-02-25 |
Last Update Date | 2022-02-10 |