| 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 |