| NPI | 1265624563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 2525) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA18346) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2010-09-21 |