| NPI | 1710304308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107759) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9107106) |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2019-11-13 |