| NPI | 1154315885 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA2248) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-00913) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2007-07-08 |