| NPI | 1376563924 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 104189) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA0961) |
| 363A00000X Physician Assistant (Licence: GA 4331) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2012-08-10 |