| NPI | 1720376684 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 11831289-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001002755) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2024-09-10 |