| NPI | 1992050975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0003497) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.005173) |
| 363A00000X Physician Assistant (Licence: MA PA5994) | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2022-02-28 |