| NPI | 1215964721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9101899) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 1115) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-01-29 |