| NPI | 1669890182 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-53295) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0003965) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2020-07-30 |