| NPI | 1396269643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09186) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9110418) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2020-10-26 |