| NPI | 1730454539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00475) | |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2017-06-02 |