NPI | 1639795594 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA OA005236) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA061574) |
Enumeration Date | 2020-06-17 |
Last Update Date | 2020-09-29 |