| NPI | 1689953127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1994) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TN 1994) |
| 363AS0400X Physician Assistant Surgical (Licence: TN 1994) | |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-08-16 |