| NPI | 1245537760 |
|---|---|
| Other Name | N/A N/A |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-78377) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 4800) |
| 207Q00000X Family Medicine (Licence: CO 4977) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2026-01-26 |