| NPI | 1588791826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WY 376) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-02260) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2014-03-03 |