NPI | 1811410053 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031359) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6261) |
Enumeration Date | 2017-07-19 |
Last Update Date | 2018-04-30 |