| NPI | 1508488933 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL TPPA987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ZZ PEJ341667) |
| 363A00000X Physician Assistant (Licence: PR PA2038) | |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2025-07-19 |