| NPI | 1104159136 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4334) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1745) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2019-04-18 |