| NPI | 1629320395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106845) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9106845) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PAT9106845) | |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2021-04-08 |