| NPI | 1831850551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9102577) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA9102577) |
| 261QP2300X Clinic/Center Primary Care (Licence: FL PA9102577) | |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-01-05 |