| NPI | 1225036973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006717) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 1808) |
| 363A00000X Physician Assistant (Licence: IL 085-002388) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-05-26 |