NPI | 1609149111 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9107939) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015441) |
Enumeration Date | 2012-02-14 |
Last Update Date | 2019-08-13 |