| NPI | 1750818241 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10071253-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005486) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2020-06-12 |