| NPI | 1063064962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008232) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 7670) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2023-12-04 |