| NPI | 1174987796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006942) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004570) |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2020-06-25 |