| NPI | 1669744199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 3310) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 2706) |
| 363AM0700X Physician Assistant, Medical (Licence: CO 3310) | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2021-03-02 |