| NPI | 1619222668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005694) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015729-1) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2019-08-23 |