| NPI | 1912040395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9103896) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9103896) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2022-09-22 |