| NPI | 1003387333 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113087) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 310462) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2020-12-18 |