| NPI | 1003092065 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 101567) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2015-0007) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2019-12-10 |