| NPI | 1023899630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 14191140-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: VA 0110009773) | |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2025-04-08 |