| NPI | 1528583762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6878) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TX PA12159) |
| 363AS0400X Physician Assistant Surgical (Licence: AZ 6878) | |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2023-08-24 |