| NPI | 1912528746 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0006625) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO PA.0006625) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2021-02-19 |