| NPI | 1750891552 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8020165-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 8020165-8906) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2017-10-05 |