| NPI | 1376911453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA910885) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PAX000011892) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2022-08-22 |