| NPI | 1982824504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0005690) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY 432) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2019-09-03 |