| NPI | 1770590481 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX pa04967) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1928) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-08 |