| NPI | 1164686861 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105070) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110002803) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2012-05-15 |