| NPI | 1699718601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN PA1528) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TX PA03140) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-11-26 |