| NPI | 1861002123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9113592) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL 9113592) |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9113592) | |
| 202C00000X Independent Medical Examiner (Licence: FL 9113592) | |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2023-08-02 |