| NPI | 1083053086 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109231) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04316) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2023-06-13 |