| NPI | 1639230816 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA05799) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA9101482) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2011-11-09 |