| NPI | 1609412634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005971) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009744) |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2021-11-12 |