| NPI | 1689337560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA15209) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2025-10-16 |