| NPI | 1760744957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114998) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056266) |
| 363A00000X Physician Assistant (Licence: DE C5-0001403) | |
| 363A00000X Physician Assistant (Licence: WI 2912) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2024-02-09 |