| NPI | 1104950633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA02992) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA052093) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-10-09 |