| NPI | 1760784656 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA 9105819) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014451) |
| Enumeration Date | 2010-11-26 |
| Last Update Date | 2018-03-17 |