| NPI | 1619584224 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA15351) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9113590) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA15351) | |
| 363A00000X Physician Assistant (Licence: FL PA9113590) | |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2023-02-07 |