| NPI | 1366673121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10090) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104693) |
| 363A00000X Physician Assistant (Licence: CA 53290) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9104693) | |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2022-06-28 |