| NPI | 1174147961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12106313-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-2213) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2022-10-25 |