| NPI | 1881641553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5972) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY WY176) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2015-09-22 |