| NPI | 1477016574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12830622-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4636-23) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2022-11-29 |