| NPI | 1063789402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106145) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT 9106145) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2023-10-19 |