NPI | 1902141104 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055975) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006520) |
Enumeration Date | 2012-11-29 |
Last Update Date | 2016-03-08 |