| NPI | 1740766658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 125134) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005433) | |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2024-09-20 |