| NPI | 1548573447 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA10080) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002130) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA054904) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2024-04-29 |