| NPI | 1023587441 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 4455) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4455-23) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2021-01-13 |