| NPI | 1407919475 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CO PA0005959) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2013-0047) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2021-05-07 |