NPI | 1619094174 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9104166) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT Q62542) |
Enumeration Date | 2007-03-22 |
Last Update Date | 2008-06-30 |