| NPI | 1376748285 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0004354) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY TL#508) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2013-05-21 |