| NPI | 1164756490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA0001619) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA0001619) |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2022-09-19 |