NPI | 1699144980 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-12129) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.005616) |
Enumeration Date | 2015-09-17 |
Last Update Date | 2023-05-05 |