| NPI | 1083632012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 1449) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA-796) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-03-06 |