| NPI | 1184667164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1144) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2008-0013) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-11-09 |