| NPI | 1366794679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA10209) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2013040410) |
| 363A00000X Physician Assistant (Licence: TX PA10209) | |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2019-10-14 |