| NPI | 1275153413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA0006792) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-008025) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2022-02-16 |