| NPI | 1619639853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13335479-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 5530) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2026-07-06 |