| NPI | 1730302191 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00089) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2120) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2014-06-05 |