| NPI | 1972275154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15585) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1191391) |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2024-03-05 |