| NPI | 1588119622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8346801-1206) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: UT 8346801-1206) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2021-09-30 |