| NPI | 1689088940 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA10338) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9618) |
| 363A00000X Physician Assistant (Licence: NC 0010-05063) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2020-05-12 |