NPI | 1649761461 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2018-0026) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2018-0026) |
Enumeration Date | 2018-05-29 |
Last Update Date | 2024-05-08 |