| NPI | 1982754693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09375) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 0083681) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2015-12-21 |