| NPI | 1710104955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08010) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004590) |
| 363A00000X Physician Assistant (Licence: CO PAL-2637) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2022-08-25 |