| NPI | 1700138617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106678) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106678) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2023-09-07 |