| NPI | 1760417299 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 2080) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 2080) |
| 363AM0700X Physician Assistant Medical (Licence: CO 2080) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2011-10-21 |