| NPI | 1649932534 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA16054) | |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2026-09-10 |