NPI | 1700038866 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA4558) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA19957) |
363AM0700X Physician Assistant, Medical (Licence: TN PA02043) | |
Enumeration Date | 2008-10-21 |
Last Update Date | 2021-02-19 |