| NPI | 1710258579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 3760) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2111) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2019-01-16 |