| NPI | 1447662929 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006023) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1000-39) |
| 363A00000X Physician Assistant (Licence: WI 4559) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-02-19 |