| NPI | 1073564936 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104905) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C50000409) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2020-09-02 |