| NPI | 1770529703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA313) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WY PA313) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2024-05-29 |