| NPI | 1649673807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0004103) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09305) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2024-08-21 |