| NPI | 1104069004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3204) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105046) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2023-02-16 |