| NPI | 1972880102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13498) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 2036) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 2036) | |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2024-01-24 |