| NPI | 1982604658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA00454) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TX PA00454) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2017-02-17 |