| NPI | 1215587647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9115540) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA061053) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2022-04-05 |