| NPI | 1629007141 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA0003952) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 103053) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2015-01-07 |