NPI | 1023774106 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2023-0248) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0007146) |
Enumeration Date | 2021-11-12 |
Last Update Date | 2024-11-12 |