| NPI | 1902814544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04837) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA04837) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2012-04-26 |