| NPI | 1730999764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PACN107) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 002409-P.A.) |
| Enumeration Date | 2025-01-11 |
| Last Update Date | 2025-10-28 |