| NPI | 1972598860 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9102291) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9102291) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102291) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2024-07-19 |