| NPI | 1477167708 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA897) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PT897) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2023-11-16 |