| NPI | 1497208292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO 06065) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019872) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2020-03-24 |