| NPI | 1578836748 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2013018090) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA 08908) |
| 363AS0400X Physician Assistant, Surgical (Licence: MO 2013018090) | |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2019-09-10 |