| NPI | 1912194820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 3002) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1051) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2021-03-10 |