| NPI | 1730557075 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2018-0075) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WA PA60582299) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2018-10-29 |