| NPI | 1477920817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13002848-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-1280) |
| 363A00000X Physician Assistant (Licence: ID TLP-054) | |
| 363AM0700X Physician Assistant Medical (Licence: ID PA-1280) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2024-02-08 |