| NPI | 1770146615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA14067) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA14067) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2021-11-12 |