| NPI | 1699239079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA OA005585) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA12590) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA062282) | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2021-06-04 |