| NPI | 1073796108 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA OA006782) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053005) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 1774) | |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2024-05-16 |