| NPI | 1780960518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11454) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-932) |
| 363A00000X Physician Assistant (Licence: AZ 5426) | |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2019-04-02 |