| NPI | 1700121381 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05747) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2692) |
| 363A00000X Physician Assistant (Licence: FL PA 9106909) | |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2015-06-08 |