| NPI | 1740837038 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT MED-PAC-LIC-103215) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PA921) |
| 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-103215) | |
| 363A00000X Physician Assistant (Licence: WY PT921) | |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2021-12-14 |