| NPI | 1811965254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NM PA2008-0033) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008335) |
| 363AM0700X Physician Assistant Medical (Licence: AZ 4181) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2013-04-26 |