| NPI | 1780032524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA1004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007768) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2024-03-28 |