| NPI | 1104475441 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58838) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0006514) | |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2022-06-06 |