| NPI | 1912596610 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17123) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9117525) |
| Enumeration Date | 2021-01-16 |
| Last Update Date | 2023-08-31 |