| NPI | 1639569577 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12108) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 2483) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2022-05-16 |