| NPI | 1083668842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2011-0042) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601002247) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2017-03-22 |