NPI | 1679149926 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 924) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005799) |
363A00000X Physician Assistant (Licence: WV 2486) | |
363A00000X Physician Assistant (Licence: PA MA062571) | |
Enumeration Date | 2021-05-27 |
Last Update Date | 2024-10-07 |