| NPI | 1790231801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0007512) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 0200571) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA 57844) | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2022-11-29 |