| NPI | 1295322972 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 14190062-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2026-05-01 |