| NPI | 1255784872 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110380) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 1818) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2019-09-23 |