| NPI | 1174071401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114661) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA TMA053097) |
| 363A00000X Physician Assistant (Licence: NY 023482) | |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2021-08-31 |