| NPI | 1790251031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX temporary) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA12415) |
| Enumeration Date | 2018-10-14 |
| Last Update Date | 2023-06-01 |