NPI | 1740899400 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 324365) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA Pending) |
Enumeration Date | 2020-07-29 |
Last Update Date | 2022-12-28 |