| NPI | 1003113424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105909) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ME PA1768) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 53608) | |
| Enumeration Date | 2011-02-21 |
| Last Update Date | 2022-01-14 |