| NPI | 1174806236 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 9059531-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C04579) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2019-11-19 |