| NPI | 1578073219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3982) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 766) |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2019-12-09 |