| NPI | 1104384015 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 4635) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4635) |
| Enumeration Date | 2019-03-10 |
| Last Update Date | 2020-01-08 |