| NPI | 1376569889 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9752) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104129) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9104129) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2023-04-21 |