| NPI | 1366954562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 0005068) |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005068) | |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2023-01-24 |