| NPI | 1487341350 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17240) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX 1212140) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA17240) | |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-11-10 |