| NPI | 1477053411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA14059) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MN 12625) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2021-03-29 |