| NPI | 1780718262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1858) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 004986) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2016-07-08 |