| NPI | 1063928240 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA11843) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11843) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2017-12-25 |
| Last Update Date | 2021-05-10 |