| NPI | 1689814352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 7232172-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA156580) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2014-03-19 |