| NPI | 1700508611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363A00000X Physician Assistant (Licence: UT 13041340-1206) | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2025-04-11 |