| NPI | 1053965574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12868) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8533-33) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2026-01-06 |