| NPI | 1790020147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA-0003862) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5310) |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2016-03-29 |