| NPI | 1689076861 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0004635) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 003186) |
| 363AM0700X Physician Assistant, Medical (Licence: CO 0004635) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004635) | |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2022-11-10 |