| NPI | 1760901409 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2017-0063) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006132) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2022-03-18 |