| NPI | 1215477765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 61683) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2017-0012) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2023-02-15 |