| NPI | 1962920199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0007345) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA059331) |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2022-08-10 |