| NPI | 1164497509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA03689) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 12233) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN PA2311) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2025-07-03 |