| NPI | 1417111246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1577) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN TN000001577) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2015-08-13 |