| NPI | 1083264766 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA12792) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9112015) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2021-01-21 |