| NPI | 1053980953 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX TEMPORARY) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PATEMP) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-09-20 |