| NPI | 1063486140 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA05206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 006136) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2017-03-08 |