| NPI | 1922179266 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09030) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT-07350) |
| 225100000X Physical Therapist (Licence: MI 5501002328) | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2022-08-16 |