| NPI | 1912278680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2383) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055329) |
| 363A00000X Physician Assistant (Licence: PA OA002781) | |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2013-09-19 |