| NPI | 1639712482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA114359) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 3597) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2025-10-29 |