| NPI | 1063600526 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA05505) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05505) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA05505) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2011-08-24 |