| NPI | 1720302680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8322950-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NV PA1211) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2019-01-29 |