| NPI | 1386515922 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA19572) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA19572) |
| Enumeration Date | 2025-09-16 |
| Last Update Date | 2025-10-03 |