| NPI | 1023254166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105404) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01612) |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2012-08-17 |