| NPI | 1578935193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2022-0112) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 019194-1) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2024-06-12 |