| NPI | 1750462099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA0000001595) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002347) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2011-04-06 |