| NPI | 1902292022 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108255) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2022-03-21 |