| NPI | 1912297458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA09719) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 002893) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2020-05-30 |