| NPI | 1063042208 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2021-0045) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM PA2021-0045) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2021-08-12 |