| NPI | 1144735580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX SA00788) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 17-102) |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2024-09-23 |