| NPI | 1063630994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA 9105577) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04411) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2012-01-25 |