| NPI | 1780964254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14353) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106116) |
| Enumeration Date | 2011-08-27 |
| Last Update Date | 2024-10-11 |