| NPI | 1902308620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12053) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2018008248) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX PA12053) | |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2025-04-25 |