| NPI | 1043215221 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT 525) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 811) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2012-09-27 |