| NPI | 1912194101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05987) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 1078253) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2009-12-14 |