| NPI | 1245619840 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12751733-8906) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA3095) |
| 363A00000X Physician Assistant (Licence: AZ 7454) | |
| 363A00000X Physician Assistant (Licence: OR PA170134) | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2024-09-23 |