NPI | 1629095641 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 192510) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00320) |
363A00000X Physician Assistant (Licence: CT 001043) | |
Enumeration Date | 2006-07-16 |
Last Update Date | 2019-12-17 |