| NPI | 1649287939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY 475) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1071) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-01-06 |