| NPI | 1447640057 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA09938) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09938) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00359600) | |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2022-05-06 |