| NPI | 1629515119 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0005647) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2023-09-19 |