| NPI | 1659820231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 11419794) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6429) |
| Enumeration Date | 2016-09-24 |
| Last Update Date | 2021-08-10 |