| NPI | 1790283208 |
|---|---|
| Other Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110971) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAX000014274) |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2019-07-30 |