| NPI | 1073173712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113204) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09549) |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2020-07-01 |