| NPI | 1912207895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 7780740-8906) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 7780740-1206) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2021-11-17 |