| NPI | 1679982821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6950) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2014-0022) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2020-09-14 |