| NPI | 1982648481 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0004023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00362) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-00362) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2018-09-04 |