| NPI | 1629325501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001009182) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA12172) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2019-12-16 |