| NPI | 1346592615 |
|---|---|
| Former Name | TARA MARIE HODGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09071) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C04875) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2020-08-28 |