| NPI | 1114315884 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 7138331-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057365) |
| 363A00000X Physician Assistant (Licence: MD C06763) | |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2021-11-04 |