| NPI | 1154304145 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0005407) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102385) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2018-10-16 |