| NPI | 1003419128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110009682) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA14907) | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2025-08-18 |