| NPI | 1932271343 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WY TL405) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY TL405) |
| 363AM0700X Physician Assistant, Medical (Licence: WY TL405) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2018-11-13 |