| NPI | 1750079844 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13141231-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 13141231-1206) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2023-08-23 |