NPI | 1891090874 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-02828) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003500) |
Enumeration Date | 2011-01-21 |
Last Update Date | 2013-11-12 |