| NPI | 1609292101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 085020) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004774) |
| 363A00000X Physician Assistant (Licence: NE 2546) | |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2022-04-14 |