| NPI | 1386924801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA12111) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 015024) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2023-10-03 |