| NPI | 1912983008 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5137) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 763) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2012-11-28 |