| NPI | 1043588700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA780) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60719694) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2019-12-13 |