NPI | 1790111490 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004813) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11502) |
363A00000X Physician Assistant (Licence: CA 55629) | |
363A00000X Physician Assistant (Licence: TX PA11166) | |
Enumeration Date | 2013-09-25 |
Last Update Date | 2021-02-18 |