| NPI | 1083903306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN TN1952) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN TN1952) |
| 363A00000X Physician Assistant (Licence: TN TN1952) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2019-04-15 |