| NPI | 1083326292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117164) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9117164) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9117164) | |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2024-03-06 |