| NPI | 1568039600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA951) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PT951) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2021-11-09 |