| NPI | 1780871368 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 6715432-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 6715432-1206) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2022-03-25 |