| NPI | 1770133761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0005980) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: WY 1220) | |
| 363A00000X Physician Assistant (Licence: OK 5511) | |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2026-04-06 |