| NPI | 1215636121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2025044201) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0007815) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2025-11-03 |