| NPI | 1760751762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 03257) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 0067) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2013-08-27 |