| NPI | 1104143700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA09144) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 005888) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2015-04-02 |