NPI | 1992001861 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9107337) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 2643-023) |
Enumeration Date | 2011-02-09 |
Last Update Date | 2024-02-08 |