| NPI | 1104572478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 221587) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15445) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2024-06-24 |