| NPI | 1912569278 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA13390) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KS 1503171) |
| Enumeration Date | 2019-07-07 |
| Last Update Date | 2025-11-03 |