| NPI | 1306115290 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004651) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.003430) |
| 363A00000X Physician Assistant (Licence: ME PA1341) | |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2016-06-13 |