| NPI | 1063751873 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110007778) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08141) |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2021-10-18 |