| NPI | 1366050353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2532) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13712) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2023-08-01 |