| NPI | 1649796335 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C06605) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0009268) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0009268) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2025-07-25 |