| NPI | 1780142539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT84477) |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: TX DT84477) | |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2025-01-24 |