| NPI | 1306053467 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA05667) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001781) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2017-04-05 |