| NPI | 1164610366 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113039) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5155) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2020-10-14 |