NPI | 1962145284 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9506) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-2259) |
Enumeration Date | 2022-04-14 |
Last Update Date | 2024-01-16 |