| NPI | 1265116321 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA17563) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA17563) |
| 363A00000X Physician Assistant (Licence: MI 5601011798) | |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2024-06-02 |