NPI | 1649818634 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4713) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-09478) |
Enumeration Date | 2019-12-20 |
Last Update Date | 2020-02-10 |