| NPI | 1255768644 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WY TL581) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0001733) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2018-08-16 |