| NPI | 1265792659 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA0004975) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05412) |
| 363A00000X Physician Assistant (Licence: CA PA22213) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2022-07-21 |