| NPI | 1760419980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9115703) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA058142) |
| 363A00000X Physician Assistant (Licence: FL PA9115703) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2022-02-17 |