| NPI | 1053416156 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1698) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00494) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2021-02-05 |