| NPI | 1184013906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2021-0125) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3468) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 4718) | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2022-02-18 |