| NPI | 1164721221 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9109436) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1967) |
| 363A00000X Physician Assistant (Licence: NC 0010-05110) | |
| 363A00000X Physician Assistant (Licence: PA MA053074) | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2024-01-05 |