| NPI | 1104486893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115339) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09149) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-09149) | |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2023-11-22 |