| NPI | 1730200486 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 3058) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY 534) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA17537) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NM PA2010-0082) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-02-19 |