| NPI | 1144556317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA17138) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363A00000X Physician Assistant (Licence: 1090615) | |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2023-11-20 |