| NPI | 1053512665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 6324228-126PA) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 6324228-4810) |
| 363A00000X Physician Assistant (Licence: UT 6324228-1206) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2021-11-22 |