NPI | 1689201113 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2023039436) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 001012109) |
363AM0700X Physician Assistant, Medical (Licence: NE 2522) | |
Enumeration Date | 2020-03-25 |
Last Update Date | 2023-10-24 |