| NPI | 1568645885 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WY 498) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CO 2492) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2013-01-25 |