| NPI | 1871189373 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2023-0201) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 59207) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2023-11-14 |