| NPI | 1568443851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA2532) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY PA109) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2019-03-01 |