| NPI | 1245444124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 2857) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010930) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2011-11-10 |