| NPI | 1548737331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4685) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2416) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 4685) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2022-08-15 |