NPI | 1851857627 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-123945) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12923) |
363AM0700X Physician Assistant, Medical (Licence: MN 12923) | |
Enumeration Date | 2019-02-15 |
Last Update Date | 2023-08-09 |