| NPI | 1154302164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3698) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 2349) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2020-02-24 |