| NPI | 1417954108 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54355) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2004-0013) |
| 363AM0700X Physician Assistant, Medical (Licence: NM PA2004-0013) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-07-21 |