| NPI | 1720732720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13820826-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA063407) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2024-06-28 |