NPI | 1831466481 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA055236) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110518) |
363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00289900) | |
Enumeration Date | 2011-11-28 |
Last Update Date | 2019-02-05 |