| NPI | 1730482209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA12835) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: UT 7841189-1206) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2021-03-08 |