| NPI | 1659749208 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16882) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60668478) |
| 363A00000X Physician Assistant (Licence: NH 1785) | |
| 363AM0700X Physician Assistant, Medical (Licence: NH 1785) | |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2023-06-01 |