| NPI | 1982035325 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA3575) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2021-05-28 |