| NPI | 1366428948 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 995) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601002946) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2019-02-13 |