| NPI | 1972913242 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003866) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 8875493-1206) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2021-05-13 |