| NPI | 1588214910 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006247) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13129) |
| 363AM0700X Physician Assistant, Medical (Licence: MN 13129) | |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2020-08-23 |