NPI | 1790211985 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55704) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07160) |
363A00000X Physician Assistant (Licence: VA 0110-005813) | |
Enumeration Date | 2017-05-07 |
Last Update Date | 2020-05-14 |