| NPI | 1124403704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108802) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108802) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9108802) | |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2023-08-30 |