| NPI | 1619445053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 14303142-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2013035877) |
| Enumeration Date | 2018-11-04 |
| Last Update Date | 2026-09-08 |