| NPI | 1710521281 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA18622) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10886) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2025-03-10 |