| NPI | 1295405439 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: UT 12488612-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-09-19 |
| Last Update Date | 2021-12-17 |