| NPI | 1063520948 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 2427) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010898) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-11-01 |