| NPI | 1356467450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2008-0062) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102801) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2009-10-08 |