| NPI | 1689150989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 295311-1206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 295311-1206) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2020-04-01 |