NPI | 1114441722 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005075) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA198541) |
363AM0700X Physician Assistant, Medical (Licence: CO PA.0005075) | |
Enumeration Date | 2017-07-26 |
Last Update Date | 2025-01-22 |