| NPI | 1962284356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17425) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.011547) |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2025-10-20 |