| NPI | 1124532478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 0000034955) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: TN 0000034955) |
| Enumeration Date | 2017-11-24 |
| Last Update Date | 2017-11-24 |