| NPI | 1790114320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0004044) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MD C0005224) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2019-12-19 |