| NPI | 1154435196 |
|---|---|
| Former Name | JENNIFER JANE OTTO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04774) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 04774t) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2019-10-16 |