| NPI | 1720108830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0002374) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05247) |
| 363A00000X Physician Assistant (Licence: CO 2374) | |
| 363AM0700X Physician Assistant, Medical (Licence: CO 2374) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO 2374) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2018-10-22 |