| NPI | 1942603097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WY PA615) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PT615) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2022-11-02 |