| NPI | 1629537345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WY PT10112) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 2341) |
| 363A00000X Physician Assistant (Licence: IA 107020) | |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2022-07-22 |