| NPI | 1902082126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA4188) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA21814) |
| 363AS0400X Physician Assistant, Surgical (Licence: LA PA.200172) | |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2019-09-17 |