| NPI | 1679238117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0009446) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9115202) |
| Enumeration Date | 2021-10-31 |
| Last Update Date | 2026-01-03 |