| NPI | 1245674944 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: LA PA.200613) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09920) |
| 363A00000X Physician Assistant (Licence: LA PA.200613) | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2021-03-30 |