| NPI | 1740874510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 12118129-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2021-10-25 |