| NPI | 1811041148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2011-0055) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 63) |
| 363AM0700X Physician Assistant, Medical (Licence: CO 63) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-06-18 |