| NPI | 1649721085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112372) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1160) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2019-11-27 |