| NPI | 1982121604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 007153) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.006235) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2023-02-21 |