| NPI | 1205143369 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108586) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4096) |
| 363A00000X Physician Assistant (Licence: CA PA 21039) | |
| 363A00000X Physician Assistant (Licence: RI PA00569) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2024-03-22 |