| NPI | 1003307422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN PA0000003565) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3565) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2020-10-30 |