| NPI | 1891124970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA205662) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA0003834) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2021-08-02 |