| NPI | 1902876246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA01721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA0001291) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA01721) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 54554) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2022-08-18 |