| NPI | 1639887011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA1061) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1195040) |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2024-12-11 |