| NPI | 1477098416 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 9758257-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT MM4109612) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2017-05-03 |