| NPI | 1790252328 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2022-0060) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 0005715) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2024-01-05 |