| NPI | 1396042073 |
|---|---|
| Former Name | CYNTHIA LAUREN DETHLEFS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07149) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2017-05-02 |