| NPI | 1902891278 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103663) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA0000001143) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2010-03-15 |