| NPI | 1922573914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2018-0082) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA207059) |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2021-11-11 |