NPI | 1639849755 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 13100576-1206) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9115034) |
363A00000X Physician Assistant | |
Enumeration Date | 2021-09-20 |
Last Update Date | 2023-06-07 |