| NPI | 1548456734 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05453) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX TEMPORARY) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2022-09-29 |