| NPI | 1871965244 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WI 5380) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09746) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2023-01-20 |