| NPI | 1063491892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY 463) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE NE692) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2010-01-13 |