| NPI | 1023361425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA619) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WY PA619) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2021-01-21 |