| NPI | 1700824638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107966) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA02625) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-10-03 |