| NPI | 1972766202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-03005) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA-2008-0010) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2021-02-16 |