| NPI | 1487939765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2057) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: TN 2057) | |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2024-09-03 |