| NPI | 1609534395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5061) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA15001) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2023-05-10 |