| NPI | 1598274862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 1144401) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2020-12-17 |