| NPI | 1275264731 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2630) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: ID 191787) |
| 207Q00000X Family Medicine (Licence: ID PA-2630) | |
| 363A00000X Physician Assistant (Licence: UT 13882004-1206) | |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2024-06-12 |