| NPI | 1740704980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005941) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 409923) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2019-10-16 |