| NPI | 1457760084 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9111150) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2144) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2019-07-18 |