| NPI | 1174612311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11784) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA18590) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA RNP381910) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-02-15 |