| NPI | 1104890672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12432) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 22297) |
| 363A00000X Physician Assistant (Licence: NV PA1792) | |
| 363A00000X Physician Assistant (Licence: MT 35362) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-06-20 |