| NPI | 1124215884 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CO 3151) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WA PA10005220) |
| 363AM0700X Physician Assistant Medical (Licence: FL PA9105019) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2012-05-10 |