| NPI | 1720159403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1863) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY 494) |
| 363AM0700X Physician Assistant, Medical (Licence: ID PA269) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2023-12-06 |