| NPI | 1104896448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 3224) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 01042) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2015-11-06 |