| NPI | 1124696810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 12342807-1206) |
| Additional Taxonomies | 208800000X Urology (Licence: UT 12342807-1206) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2021-11-11 |