| NPI | 1780626648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004686) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005804) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-07-21 |