| NPI | 1528363264 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04269) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105749) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2020-06-23 |