| NPI | 1396086179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107063) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA 9107063) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9107063) | |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2022-07-20 |