NPI | 1619316767 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2023046482) |
Additional Taxonomies | 183500000X Pharmacist (Licence: OK 15382) |
363A00000X Physician Assistant (Licence: OK 4488) | |
363A00000X Physician Assistant (Licence: KS 15-02858) | |
Enumeration Date | 2013-06-21 |
Last Update Date | 2024-01-19 |