| NPI | 1821641051 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA12885) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA12885) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2021-09-01 |