| NPI | 1326691569 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 11868464-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9112272) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2021-01-25 |