| NPI | 1558378372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WY 399) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA450) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2011-03-22 |