| NPI | 1871037747 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0005677) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA10852) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2019-04-01 |