| NPI | 1811688088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO MSPA.0000010) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX pa15862) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-08-20 |