NPI | 1083811053 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108704) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 12213) |
Enumeration Date | 2007-07-02 |
Last Update Date | 2025-09-29 |