| NPI | 1073112488 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA14006) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2024-01-08 |