| NPI | 1871766543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11143) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1586) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 1586) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2023-02-24 |