NPI | 1669060562 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-2540) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 58792) |
Enumeration Date | 2021-01-06 |
Last Update Date | 2023-09-13 |