| NPI | 1891170064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12727989-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA180723) |
| 363AM0700X Physician Assistant, Medical (Licence: OR PA180723) | |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2023-04-26 |