NPI | 1639546914 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 52678) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52678) |
Enumeration Date | 2015-08-21 |
Last Update Date | 2022-02-11 |