| NPI | 1861764268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12296766-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: SC 2738) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2021-07-30 |