| NPI | 1760040463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15006) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02246) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2022-03-23 |