| NPI | 1184205650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15635) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9114256) |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9114256) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL 9114256) | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2022-04-28 |