| NPI | 1700068699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05452) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX PA05452) |
| 363A00000X Physician Assistant (Licence: NM PA2007-0040) | |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2022-07-28 |