| NPI | 1013266675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 007892) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 6556) |
| 363AM0700X Physician Assistant, Medical (Licence: GA 6556) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2024-03-08 |