| NPI | 1184123697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14613) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07635) |
| 363A00000X Physician Assistant (Licence: CO 0005885) | |
| Enumeration Date | 2018-02-10 |
| Last Update Date | 2021-09-14 |