| NPI | 1205890076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK PADA609) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-129627) |
| 363A00000X Physician Assistant (Licence: CO PA.0004113) | |
| 363A00000X Physician Assistant (Licence: NM PA2014-0035) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2024-11-13 |