| NPI | 1255614970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07680) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2011-0032) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2020-09-02 |