| NPI | 1962952614 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115183) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5930) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2021-11-08 |