| NPI | 1356572580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WY TL478) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: WY TL478) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2021-07-26 |