NPI | 1770900086 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA5976) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 4374) |
Enumeration Date | 2014-03-25 |
Last Update Date | 2020-01-30 |