| NPI | 1083477228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2024-0005) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2024-0005) |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2024-03-12 |