| NPI | 1790012177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06866) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105116) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 013711) | |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2018-03-17 |