| NPI | 1215456272 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11449) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX pa11449) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX PA11449) | |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2022-01-26 |