| NPI | 1366703118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07112) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX PA07112) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA07112) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2012-07-17 |