| NPI | 1750387254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9102688) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601011153) |
| 363A00000X Physician Assistant (Licence: IN 10004061A) | |
| 363A00000X Physician Assistant (Licence: NY 026644) | |
| 363A00000X Physician Assistant (Licence: IL 085009418) | |
| 363A00000X Physician Assistant (Licence: CA 59596) | |
| 363A00000X Physician Assistant (Licence: GA 10509) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2024-03-13 |