| NPI | 1407060908 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12779730-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MA AP1948) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2023-08-07 |