| NPI | 1003898149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12422287-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: OR 152511) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2022-04-25 |