| NPI | 1467947531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA12070) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12070) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2020-01-14 |