| NPI | 1063722411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4157) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WI 1842-029) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2018-03-17 |