| NPI | 1912453143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2021-0016) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2021-08-05 |