| NPI | 1689187627 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 104183641206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 10418364-1206) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2021-11-11 |