| NPI | 1528091295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN PA666) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2674) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2018-08-13 |