| NPI | 1366746422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005101) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21393) |
| 363AM0700X Physician Assistant, Medical | |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 4888) | |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2019-06-11 |