| NPI | 1568658128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2007-0026) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NM PA2007-0026) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2020-12-09 |