| NPI | 1548513468 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA003004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055804) |
| 363A00000X Physician Assistant (Licence: WY PT693) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2017-03-09 |