| NPI | 1366799892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA2767) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002794) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL 9107233) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2015-07-22 |