| NPI | 1235503848 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8432) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA10240) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2020-10-15 |