| NPI | 1609815828 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA04325) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA04325) |
| 363AS0400X Physician Assistant, Surgical (Licence: MD PA58950) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2011-08-15 |