| NPI | 1093132706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA16363) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WY PA842) |
| 363AS0400X Physician Assistant Surgical (Licence: AZ 5642) | |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2023-03-02 |