| NPI | 1841691136 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5412) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9108156) |
| Enumeration Date | 2014-09-06 |
| Last Update Date | 2021-10-04 |