| NPI | 1679710149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA 9108977) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053583) |
| 363A00000X Physician Assistant (Licence: SC 1886) | |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2016-01-05 |