NPI | 1649818816 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C07968) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007830) |
363A00000X Physician Assistant (Licence: MD c0007968) | |
Enumeration Date | 2019-12-18 |
Last Update Date | 2021-11-11 |