| NPI | 1265213169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13628939-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2024-04-15 |