| NPI | 1710973177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WY 202) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WY 202) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2012-08-27 |