| NPI | 1639571961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108237) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9108237) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2021-05-10 |