| NPI | 1841273554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2016-0044) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 2103) |
| 363A00000X Physician Assistant (Licence: CO PA.0003777) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2017-02-08 |