| 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 |