| NPI | 1467040204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8720) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 8720) |
| 363AM0700X Physician Assistant, Medical (Licence: TX 718429) | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2023-03-08 |