| NPI | 1730189911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00375) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA0002546) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2010-09-15 |