| NPI | 1962809954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006357) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 8450) |
| 363A00000X Physician Assistant (Licence: NE 1865) | |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2020-09-14 |