| NPI | 1659602100 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 14164631-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5892) |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 5892) | |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2025-04-22 |