| NPI | 1912552555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2022-0107) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2025-08-25 |