| NPI | 1982713764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WY 337) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA0002070) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-03-03 |