| NPI | 1154579357 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05904) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008915RX) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2024-09-09 |