| NPI | 1003329962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 10560992-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 10560992-1206) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2017-12-08 |