| NPI | 1215604012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 12945877-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 12945877-1206) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2024-10-14 |