| NPI | 1588640221 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM 92-PA17) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM R10041) |
| 207Q00000X Family Medicine (Licence: NM 92-PA17) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2012-01-17 |