| NPI | 1912681800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY PA1348) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363A00000X Physician Assistant (Licence: VA 0110009382) | |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2025-12-16 |