| NPI | 1811389356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA11791) |
| Additional Taxonomies | 247200000X Technician, Other |
| 363A00000X Physician Assistant (Licence: VA 0110008213) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NM PA2018-0018) | |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2023-12-20 |