| NPI | 1992158414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12850) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA058290) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2021-06-03 |