| NPI | 1538462155 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX 10-148) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TX 10-148) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2010-12-21 |