| NPI | 1417129123 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003398) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 3398) | 
| Enumeration Date | 2008-04-02 | 
| Last Update Date | 2021-11-17 |