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 |