| NPI | 1134477490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115997) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015862) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2024-01-08 |