| NPI | 1366817066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9107792) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9107792) |
| 363A00000X Physician Assistant (Licence: NC 0010-06300) | |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2017-02-15 |