| NPI | 1912139650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO 115521) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: CO 115521) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2015-03-05 |