| NPI | 1780492124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA20315) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA20315) |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2026-04-03 |