| NPI | 1649465857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109706) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0119001) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2018-03-17 |