| NPI | 1689224073 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2019-0065) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NM PA2019-0065) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2019-11-18 |