| NPI | 1255570396 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 1510) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 15402) |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2012-11-07 |