| NPI | 1003555152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9121650) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15974) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2026-07-02 |