| NPI | 1194890590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY 292) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 292) |
| 207Q00000X Family Medicine (Licence: WY 292) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-02-01 |