| NPI | 1649525817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 076271) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0003460) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2022-07-21 |