| NPI | 1548870975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12431) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9113160) |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9113160) | |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2023-10-03 |