| NPI | 1336923135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 14063220-1206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 14063220-8906) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: UT 14063220-8906) | |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2024-08-11 |