| NPI | 1487173928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10495455-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: UT 10495455-1206) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2018-05-18 |