| NPI | 1568020113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3558) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX TEMP) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2022-05-09 |