| NPI | 1720403702 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006573) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 56010006897) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2021-04-05 |