| NPI | 1063407930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113677) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 608023) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2025-12-03 |