| NPI | 1639714835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0007320) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9112515) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2026-09-01 |