| NPI | 1417200346 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC124) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9106802) |
| 363AM0700X Physician Assistant, Medical (Licence: SC MPA2654) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2023-09-21 |