| NPI | 1861597080 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04850) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002030) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA 04580) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2023-10-18 |