| NPI | 1194078501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8461958-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1511) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2024-11-27 |