| NPI | 1760969513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111209) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL PA) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2019-04-16 |