| NPI | 1558354878 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12456) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2743) |
| 363A00000X Physician Assistant (Licence: FL PA9102571) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9102571) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102571) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2019-04-08 |