| NPI | 1629054648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX AP08625) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002198) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2022-01-04 |