| NPI | 1750964797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4552) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA14585) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2023-03-15 |