| NPI | 1073920005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA09328) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2024-12-30 |