| NPI | 1073149324 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114649) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2024-06-11 |