| NPI | 1962750117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 9259829-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2022-08-05 |