| NPI | 1871847384 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA0007976) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA055863) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2023-07-20 |