| NPI | 1790300754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12954328-1206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA60433) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2023-03-09 |