| NPI | 1164815288 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004951) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05689) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2021-01-30 |