| NPI | 1770161069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA14485) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA14485) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2026-01-29 |