| NPI | 1902177603 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07964) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2063) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2022-05-05 |