| NPI | 1194915496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 007088) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03244) |
| 363A00000X Physician Assistant (Licence: TN 1512) | |
| 363AM0700X Physician Assistant, Medical (Licence: TN 1512) | |
| 363AS0400X Physician Assistant, Surgical (Licence: TN PA0000001512) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2020-06-02 |