| NPI | 1629403407 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2014009416) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9107392) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2017-11-09 |