| NPI | 1073564969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 1953) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-01298) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2020-09-28 |