| NPI | 1174102115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14493) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114104) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2024-07-27 |