| NPI | 1083965255 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 329480) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA14984) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2022-09-28 |