| NPI | 1871656462 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.000845) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9101686) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9101686) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2024-05-09 |