| NPI | 1962243444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.8612) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: CO PA.8882) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008612) | |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2025-02-10 |