| NPI | 1902896855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA12104) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA A10195) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2020-01-23 |