| NPI | 1730433517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006452) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4489) |
| 363A00000X Physician Assistant (Licence: MI 5601007097) | |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2022-03-16 |