| NPI | 1780961417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 56072) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 3347) |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2020-03-25 |