| NPI | 1073075453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117269) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007501) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2023-10-13 |