| NPI | 1104545169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX PA18848) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 333126) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2025-07-17 |