| NPI | 1669072864 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO 008069) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 008069) |
| 363A00000X Physician Assistant (Licence: NY 025863) | |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2023-09-29 |