| NPI | 1235410903 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA09686) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MA PA4192) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2022-03-14 |