| NPI | 1417382789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: UT 6377270-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 6377270-1206) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2021-10-16 |