| NPI | 1376015297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 9114792) |
| Additional Taxonomies | 2086S0129X (Licence: CO 841033516) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005583) | |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2023-07-09 |