NPI | 1679681035 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA156252) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103873) |
363A00000X Physician Assistant (Licence: TN PA0000000970) | |
363A00000X Physician Assistant (Licence: NC 133447) | |
Enumeration Date | 2006-08-27 |
Last Update Date | 2012-01-13 |