| NPI | 1558762435 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0004037) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PA659) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2021-02-06 |