| NPI | 1043207756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2008-0068) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA880) |
| 363AM0700X Physician Assistant, Medical (Licence: AK 714) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2017-01-18 |