| NPI | 1821497561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3789) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004011) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA09902) | |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2022-08-29 |