NPI | 1629448501 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 4357) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0005948) |
Enumeration Date | 2015-10-05 |
Last Update Date | 2022-06-23 |