NPI | 1720328248 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00622) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22802) |
363A00000X Physician Assistant (Licence: NC 0010-09475) | |
Enumeration Date | 2013-02-20 |
Last Update Date | 2022-09-01 |