| NPI | 1083087944 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 9537931-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PT654) |
| Enumeration Date | 2015-11-01 |
| Last Update Date | 2015-11-21 |