| NPI | 1700342623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0009180) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060506) |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2025-08-01 |