| NPI | 1912275199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1714) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106798) |
| 363A00000X Physician Assistant (Licence: TN 2722) | |
| 363AM0700X Physician Assistant, Medical (Licence: SC 1714) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2020-11-24 |