NPI | 1730633868 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR OMBPA179664) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA179664) |
363A00000X Physician Assistant (Licence: OR OMBPA179664) | |
Enumeration Date | 2016-08-05 |
Last Update Date | 2021-01-15 |