| NPI | 1053468892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05086) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA05086) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085-002928) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-04-13 |