| NPI | 1134378219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104759) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PAT 9104759) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2019-05-30 |