| NPI | 1750904058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 4792) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006417) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2022-07-19 |