| NPI | 1114459443 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX 0102208097) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11164) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-07-31 |