| NPI | 1669907762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114541) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-005834) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2022-01-19 |