| NPI | 1518319300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA11502) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VA 0110005427) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2024-04-17 |