| NPI | 1790114296 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4686) |
| Additional Taxonomies | 284300000X Special Hospital (Licence: TX PA1101) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2020-02-07 |