| NPI | 1972105898 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA18258) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 027233) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA062138) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2024-10-30 |