| NPI | 1891294989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10493849-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 7143) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2019-09-17 |