| NPI | 1710304902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14538) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227015833) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2022-03-08 |