NPI | 1669152328 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17976) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant Medical (Licence: TX PA17976) | |
Enumeration Date | 2023-07-18 |
Last Update Date | 2024-05-31 |