NPI | 1609954585 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601009932) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10005245) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2023-04-28 |