| NPI | 1205358157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15333) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006207) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 020962) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2022-04-20 |