NPI | 1861632143 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA4709) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA06751) |
363AM0700X Physician Assistant, Medical (Licence: CA PA20233) | |
Enumeration Date | 2009-02-26 |
Last Update Date | 2019-06-17 |