| NPI | 1063965671 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: UT 10091048-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-07-31 |
| Last Update Date | 2023-02-08 |