| NPI | 1205449402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 12691635-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2022-07-01 |