NPI | 1679775589 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002407) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD c0003515) |
Enumeration Date | 2007-06-03 |
Last Update Date | 2021-06-02 |