| NPI | 1619296589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9113534) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD 410) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 5107) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2020-12-02 |