| NPI | 1104565233 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 8900-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 332058) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2026-08-04 |