| NPI | 1710255633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109346) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015374) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2024-01-16 |