| NPI | 1043609472 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06884) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2703) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2022-01-07 |