| NPI | 1053040568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA15885) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15885) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2025-08-19 |