| NPI | 1477067239 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CT 5030) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0005175) |
| 363A00000X Physician Assistant (Licence: CA 62769) | |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2023-06-29 |