| NPI | 1982741492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9103681) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 201550-1206) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2017-01-08 |