| NPI | 1710684667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 14046439-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2831) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2024-08-14 |