| NPI | 1124395025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07548) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT06509) |
| Enumeration Date | 2011-11-20 |
| Last Update Date | 2012-11-09 |