| NPI | 1952738387 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WY PA642) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant Surgical (Licence: AZ 5489) | |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2022-11-04 |