| NPI | 1023566130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005781) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601007917) |
| Enumeration Date | 2016-09-18 |
| Last Update Date | 2019-08-26 |