| NPI | 1164463568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2013-0007) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA-80) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2018-01-30 |