| NPI | 1821320656 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN TEMPORARY PERMIT) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA0000001820) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2013-02-01 |