| NPI | 1649897455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58269) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13923) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA13923) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA58269) | |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA13923) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA58269) | |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2020-11-25 |