| NPI | 1497154975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA676) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 2107) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO 2107) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2023-01-09 |