| NPI | 1669769584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0008049) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WI 2779-23) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2024-01-05 |