| NPI | 1104888320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 56) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 425) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2016-11-01 |