| NPI | 1790838266 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06460) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CO 1179) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2023-03-07 |