NPI | 1982786752 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 19770) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2005031147) |
363AM0700X Physician Assistant, Medical (Licence: KS 1501035) | |
Enumeration Date | 2006-10-20 |
Last Update Date | 2009-10-01 |