| NPI | 1174127559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113629) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 10237) |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2024-03-15 |