| NPI | 1053685354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14056) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106439) |
| Enumeration Date | 2012-03-04 |
| Last Update Date | 2024-08-07 |