| NPI | 1619094174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9104166) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CT Q62542) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-06-30 |