| NPI | 1720461775 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108743) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2015021174) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2016-09-13 |