NPI | 1912328360 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05744) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085004944) |
363AM0700X Physician Assistant, Medical (Licence: IN 10001593A) | |
Enumeration Date | 2014-01-01 |
Last Update Date | 2025-07-11 |