| NPI | 1205488558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 9077851-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 9077851-8906) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2022-03-08 |