| NPI | 1912097031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07670) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 01744T) |
| 363A00000X Physician Assistant (Licence: MN 10407) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2021-03-21 |