| NPI | 1700834686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 9454093-1206) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY PA920) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2017-03-29 |