| NPI | 1114335965 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 010005755) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09263) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2021-06-24 |