| NPI | 1124564174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11065) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 2767) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2017-01-15 |
| Last Update Date | 2021-02-02 |