NPI | 1598274862 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110811) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 1144401) |
Enumeration Date | 2017-09-29 |
Last Update Date | 2020-12-17 |