| NPI | 1225283963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA05955) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05955) |
| 363A00000X Physician Assistant (Licence: MN 12533) | |
| 363AM0700X Physician Assistant Medical (Licence: TX PA05955) | |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2023-04-27 |