| NPI | 1952994592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14495) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2021-09-15 |