| NPI | 1083693139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 101918-1206) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2007-07-08 |