| NPI | 1780352401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0007744) |
| 363A00000X Physician Assistant (Licence: OR PA228221) | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2026-01-22 |