| NPI | 1871139048 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 11484934-1206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11484934-1206) |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2021-07-20 |