| NPI | 1184358012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17428) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA063692) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2024-12-19 |