| NPI | 1962459040 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4309) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: UT 5179956-1205) |
| 363AM0700X Physician Assistant, Medical (Licence: CO 3135) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2019-11-05 |