| NPI | 1710591516 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-14183) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-14183) |
| 363A00000X Physician Assistant (Licence: FL PA9113596) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9113596) | |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2024-10-03 |