| NPI | 1508480542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PT909) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006279) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-12-04 |