| NPI | 1851984041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA14329) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX TEMPORARY) |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2023-01-25 |