| NPI | 1063705556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004180) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 002561) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2019-07-15 |