| NPI | 1871569855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9109580) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN PA642) |
| 363AM0700X Physician Assistant, Medical (Licence: SC TL1232) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2020-05-06 |