| NPI | 1720509821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA18597) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2025-01-09 |