| NPI | 1205481801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 11856778-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA195066) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2024-09-19 |