| NPI | 1245674944 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09920) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9113256) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 58077) | |
| 363AM0700X Physician Assistant, Medical (Licence: UT 14153860-1206) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2024-11-15 |