| NPI | 1417508656 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9755) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007219) |
| 363A00000X Physician Assistant (Licence: FL 9112626) | |
| 363A00000X Physician Assistant (Licence: NC 0010-10483) | |
| 363A00000X Physician Assistant (Licence: TN PA0000004155) | |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2022-04-29 |