| NPI | 1720481120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004408) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WY PT616) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2018-05-29 |