| NPI | 1669851945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2015-0038) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 13948513-1206) |
| 363AS0400X Physician Assistant Surgical | |
| 363A00000X Physician Assistant (Licence: NV PA2924) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2024-07-10 |