NPI | 1700273091 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA031150) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C05821) |
Enumeration Date | 2015-04-24 |
Last Update Date | 2015-10-12 |