| NPI | 1730253063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM 86-PA052) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 244) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 102676) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2021-04-07 |