| NPI | 1528105699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00116) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX SA00116) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-11-05 |