| NPI | 1043633258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-2070) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08642) |
| 363A00000X Physician Assistant (Licence: NM PA201-0093) | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2021-07-28 |