| NPI | 1710262860 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 372963-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 372963-1206) |
| 363A00000X Physician Assistant (Licence: CA PA21756) | |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2023-06-21 |