| NPI | 1407622848 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA1209) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0008257) |
| Enumeration Date | 2023-11-28 |
| Last Update Date | 2024-04-29 |