| NPI | 1104933589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14911) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07543) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-09-21 |