| NPI | 1790137008 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13669) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA059194) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2020-10-19 |