| NPI | 1275790107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05766) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 1077371) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA05766) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2013-08-28 |