| NPI | 1649546870 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL PA9106387) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106387) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2021-05-17 |