| NPI | 1700813581 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA062343) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT830) |
| 363A00000X Physician Assistant (Licence: FL PA9112078) | |
| 363A00000X Physician Assistant (Licence: GA 5762) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9112078) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2024-10-17 |