| NPI | 1205956034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 3154) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601004764) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2011-09-06 |