| NPI | 1366693103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002185) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104776) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2009-02-01 |