| NPI | 1972125631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113977) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9113977) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2022-04-14 |