| NPI | 1750742136 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110483) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL MN6169177) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA058138) | |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2022-07-21 |