| NPI | 1366701658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PT908) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106440) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2020-11-16 |