| NPI | 1851830962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA10992) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA10992) |
| 363AS0400X Physician Assistant, Surgical (Licence: NM PA2020-0029) | |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2022-07-21 |