| NPI | 1245067164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119047) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-14423) |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2025-01-15 |