| NPI | 1194011064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105639) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110004640) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2023-03-06 |