| NPI | 1619484797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NV PA0393) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11995) |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2020-11-23 |