| NPI | 1720621600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112699) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2019-11-18 |