| NPI | 1174756779 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110511) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 002013) |
| Enumeration Date | 2009-08-29 |
| Last Update Date | 2021-03-29 |