| NPI | 1104210863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10283) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 7529) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2016-04-11 |