| NPI | 1336818517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114886) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9114886) |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2021-12-09 |