| NPI | 1528264694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108750) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00933) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2019-09-20 |