| NPI | 1003393737 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008322) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0005244) |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005244) | |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2024-04-10 |