| NPI | 1124896774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA19019) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-12-13 |
| Last Update Date | 2026-03-12 |