| NPI | 1114110921 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 5190165-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 5190165-1206) |
| 133V00000X Dietitian, Registered (Licence: UT 5190165-4901) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2016-06-23 |